Executive Attention and Empathy-Related Responses in Boys with Oppositional Defiant Disorder or Conduct Disorder, With and Without Comorbid Anxiety Disorder

The mediators for the link between autism and real-world executive functions in adolescence and young adulthood

LAY ABSTRACT

Childhood factors that predict real-world executive function in autism spectrum disorder during the transition into adulthood are largely unknown. This study aimed to identify the predictors for the behavioral and cognitive aspects of real-world executive function in late adolescent and young adult autistic populations. We followed up 289 autistic youth (mean age 11.6 years) and 203 non-autistic controls (10.7 years) to their ages of 16.9 and 15.8, respectively. The Behavior Rating Inventory of Executive Function scale was used to measure the real-world executive function at late adolescence and young adulthood at follow-up. Potential predictors such as autistic symptoms, inattention or hyperactivity symptoms, peer relationship, emotional symptoms, and parenting styles were assessed in childhood at first enrollment. The results showed that childhood inattention, withdrawn behaviors, social communication difficulties, and child-reported emotion and inattention/hyperactivity may predict real-world lower executive function in late adolescence and young adults with autism. When separating executive function into behavioral and cognitive aspects, we found that oppositional behaviors and peer problems were specific predictors for behavioral regulation and cognitive function, respectively. Our findings suggested that treating common predictors in childhood, such as inattention, may potentially improve real-world executive function in autism during the transition into adulthood.

Neurodevelopmental risk and adaptation as a model for comorbidity among internalizing and externalizing disorders: genomics and cell-specific expression enriched morphometric study

BACKGROUND

Comorbidity is the rule rather than the exception for childhood and adolescent onset mental disorders, but we cannot predict its occurrence and do not know the neural mechanisms underlying comorbidity. We investigate if the effects of comorbid internalizing and externalizing disorders on anatomical differences represent a simple aggregate of the effects on each disorder and if these comorbidity-associated cortical surface differences relate to a distinct genetic underpinning.

METHODS

We studied the cortical surface area (SA) and thickness (CT) of 11,878 preadolescents (9-10 years) from the Adolescent Brain and Cognitive Development Study. Linear mixed models were implemented in comparative and association analyses among internalizing (dysthymia, major depressive disorder, disruptive mood dysregulation disorder, agoraphobia, panic disorder, specific phobia, separation anxiety disorder, social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder), externalizing (attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder) diagnostic groups, a group with comorbidity of the two and a healthy control group. Genome-wide association analysis (GWAS) and cell type specificity analysis were performed on 4468 unrelated European participants from this cohort.

RESULTS

Smaller cortical surface area but higher thickness was noted across patient groups when compared to controls. Children with comorbid internalizing and externalizing disorders had more pronounced areal reduction than those without comorbidity, indicating an additive burden. In contrast, cortical thickness had a non-linear effect with comorbidity: the comorbid group had no significant CT differences, while those patient groups without comorbidity had significantly higher thickness compare to healthy controls. Distinct biological pathways were implicated in regional SA and CT differences. Specifically, CT differences were associated with immune-related processes implicating astrocytes and oligodendrocytes, while SA-related differences related mainly to inhibitory neurons.

CONCLUSION

The emergence of comorbidity across distinct clusters of psychopathology is unlikely to be due to a simple additive neurobiological effect alone. Distinct developmental risk moderated by immune-related adaptation processes, with unique genetic and cell-specific factors, may contribute to underlying SA and CT differences. Children with the highest risk but lowest resilience, both captured in their developmental morphometry, may develop a comorbid illness pattern.

A psychophysiological investigation of mourning: There are two sides to the story

Mourning constitutes an important human emotion, which might cause—among other things—major depressive symptoms when lasting for too long. To date, no study investigated whether mourning is related to specific psychophysiological activation patterns. Therefore, we examined physiological reactions induced by iconographic mourning-related stimuli in comparison to neutral and attachment stimuli in healthy adults (N = 77, mean age: 21.9). We evaluated pupillometric and eye-tracking parameters as well as heart rate variability (HRV) and skin conductance (EDA). Eye-tracking revealed a stronger dilated pupil during mourning in comparison to the neutral, but not to the attachment condition; furthermore, fixation patterns revealed less fixations on mourning stimuli. While HF HRV was reduced during mourning and attachment, we found no differences concerning EDA parameters between conditions. Results suggest specific eye-movement and pupil adaptations during representations of mourning, which might point toward inward cognition or avoidance, but no specific physiological pattern concerning HRV and EDA.

Development and psychometric characteristics of analog measures of parental empathy

Despite substantial literature on the effect of empathy on parenting, empathy research has historically suffered from definitional and methodological limitations. Parental empathy can be characterized as parents’ ability to recognize, take the perspective of, and appropriately react to children’s emotions. Current parental empathy assessment largely relies on self-report measures of dispositional empathy, but many argue parental empathy is distinct from dispositional empathy. Despite efforts to measure parental empathy implicitly, such analog approaches are labor intensive. The current report describes the preliminary development of the Empathy Measure for Parents Analog Task (EMPAT), two novel analog measures of parental empathy: one EMPAT analog uses audio stimuli and a second version uses written evocative scripts. After piloting with a sample of undergraduate students (Study 1), the measures were then administered to a sample of 212 parents (Study 2). For each study, the accuracy of the audio and script stimuli were first confirmed by examination of frequency distributions, then exploratory factor analyses were conducted to determine factor structure for each emotion subscale (i.e., Happy, Mad, Sad, Scared), and finally the composition of each emotion subscale was confirmed with scale reliability analyses. Correlations between each EMPAT version and measures of dispositional empathy, parental empathy, and positive parenting indicators were examined to assess the initial validity of the EMPAT measures. The new analog tasks demonstrated good reliability as well as preliminary evidence of validity, with potential utility in assessing cognitive elements of empathy in particular. With continued efforts to examine measure validity, the implications of these studies suggest the EMPAT tasks show promise in providing improved implicit, efficient assessments of child-directed empathy, which may be important for understanding positive and problematic parenting.

Disruptive Behavior Disorders and Psychopathic Traits in Adolescents: Empathy-Related Responses to Witnessing Animal Distress

Cruelty to animals is a symptom of conduct disorder and associated with psychopathic traits in childhood. One of the factors thought to contribute to animal cruelty is reduced empathy and concern for the well-being of animals. A first aim of this study was to examine empathy towards animals in distress in male adolescents with disruptive behavior disorders (DBD) and high or low psychopathic traits, and normal controls (NC). Psychopathic traits were assessed by the Antisocial Process Screening Device (APSD). Respondents were exposed to a short film clip depicting a baby bear in distress. Heart rate (HR) responses were monitored during film exposure. Afterwards, respondents were asked to report the emotions they had observed and experienced. Contrary to expectations based on research on human empathy, no group differences were found in empathy-related responses to witnessing animal distress. Both DBD groups and normal controls observed equal levels of distress in the baby bear, experienced as much empathy and sympathy, and showed similar levels of HR reduction during the most dramatic scene. Results suggest that empathy for humans does not generalize to animals, and vice versa. A second aim was to examine the associations between empathy-related responses and the broad concept of psychopathy as well as its dimensions. The relationships were different and for the most part reversed in the NC and DBD groups. Group proved to be an important moderating factor, indicating that results obtained within a sample of healthy adolescents do not generalize to adolescents with DBD, and vice versa.

The Role of Executive Functions in the Development of Empathy and Its Association with Externalizing Behaviors in Children with Neurodevelopmental Disorders and Other Psychiatric Comorbidities

Executive functions have been previously shown to correlate with empathic attitudes and prosocial behaviors. People with higher levels of executive functions, as a whole, may better regulate their emotions and reduce perceived distress during the empathetic processes. Our goal was to explore the relationship between empathy and executive functioning in a sample of children and adolescents diagnosed with Attention Deficit and Hyperactivity Disorder alone or associated with comorbid Disruptive Behavior Disorders and/or Autism Spectrum Disorder. We also aimed to examine the role of empathic dimensions and executive skills in regulating externalizing behaviors. The 151 participants with ADHD were assigned to four groups according to their psychiatric comorbidity (either "pure" or with ASD and/or ODD/CD) and assessed by means of either parent- or self-reported questionnaires, namely the BRIEF-2, the BES, and the IRI. No questionnaire was found to discriminate between the four groups. Affective Empathy was found to positively correlate with Emotional and Behavioral Regulation competences. Furthermore, Aggressiveness and Oppositional Defiant Problems were positively associated with Executive Emotional and Behavioral Regulation competences. On the other hand, Rule-Breaking Behaviors and Conduct Problems were negatively associated with Affective Empathy and with Behavioral skills. Our study provides an additional contribution for a better understanding of the complex relationship between empathic competence and executive functions, showing that executive functioning and empathic attitudes interact with each other to regulate aggressive behaviors. This study further corroborates developmental models of empathy and their clinical implications, for which externalizing behaviors could be attenuated by enhancing executive functioning skills.

Perspectives on clinical guidelines for severe behavioural problems in children across Europe: a qualitative study with mental health clinicians

Clinical guidelines for severe behavioural problems (SBPs) in children have recently been developed in several European countries. However, questions emerged regarding their applicability to practice. Our study aimed to provide a first European insight into guidelines' fitness-for-purpose by exploring mental health clinicians' familiarity with, use and perceived value of guidelines for SBPs in children. Participants included 161 clinicians, primarily psychiatrists, from 24 countries. Clinicians completed a semi-structured qualitative questionnaire on existing SBPs guidelines and development of new guidelines where not available. Clinicians' responses were mapped against academic experts' perceptions on SBPs guidelines highlighted in a previous study (Gatej et al. in Eur Psychiatry 57:1-9, 2019). Under half of the clinicians reported being unaware of guidelines. Of these, 37.6% represented countries where guidelines were available according to experts. The remaining half of clinicians who were aware of guidelines on average reported being moderately familiar with their content, perceiving them as moderately useful and using them some of the time. Additionally, 60.8% clinicians agreed that SBPs guidelines need to be developed, as these would create a shared scientific knowledge base and common practice. Guideline improvements included taking a multifactorial approach, creating specific case recommendations, and dissemination efforts. The modest familiarity with and use of guidelines amongst practitioners may highlight guidelines poor fitness-for-purpose, or, alternatively, an underlying confusion around the meaning and purpose of guidelines. Moving forward, efforts should be directed at disseminating clearer definitions of guidelines, addressing existing challenges, and unifying efforts to further develop and audit application of international guidelines for SBPs.